How to Treat Conduct Disorder

This article was co-authored by Trudi Griffin, LPC. Trudi Griffin is a Licensed Professional Counselor in Wisconsin. She received her MS in Clinical Mental Health Counseling from Marquette University in 2011.

There are 21 references cited in this article, which can be found at the bottom of the page.

Conduct disorder (CD) is identified in a child or adolescent through symptoms including aggression, deliberate property damage, repeated violations at home, school, or work, and persistent lying to avoid consequences.[1] Conduct disorder also can include bullying, starting fights, theft, vandalism, shoplifting, skipping school, and cruelty to people and animals. When diagnosing conduct disorder, a professional may consider and rule out oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), and mood disorder.[2] Seek out a therapist when treating conduct disorder.

Seek therapy. Conduct disorder is very hard to treat without therapeutic intervention. Seek a therapist experienced with working with children and families around issues of conduct disorder. A comprehensive therapist may gather information from the parents, child, and family, in addition to information from the school, community, and the legal system (if applicable).[3]

Strategies for addressing conduct disorder often involve implementing cognitive-behavior therapy (CBT) and parent education/training.[4] Look for a therapist who will work with parents and the whole family.

Treat substance abuse first. If a child presents with substance abuse, treat the substance abuse first before treating the conduct disorder.[5] Behavior and psychological treatment will likely be less effective when it’s done with the presence of substance abuse.

Be aware of any cigarette use, cannabis use, prescription drug use, or the use of hard drugs.

Address other psychological conditions. It’s likely that a child with CD may have other mental health problems as well, including attention-deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD). Some may develop PTSD as a result of violence in the home. A child may witness violence from one parent to the other, from a parent to a sibling, or may experience violence from the parent to the self. These events can be quite damaging, and may leave a lasting impact on the child. For treatment to be effective, it’s important to address any co-occurring disorders.[6]

A child or adolescent may also suffer from depression, anxiety, or another psychological diagnosis that impacts mood and functioning. Talk to your therapist about identifying symptoms.

Obtain medication. While medication appears to be ineffective at treating conduct disorder[7], medication may be beneficial for treating co-occurring disorders such as ADHD, depression, or anxiety. It is best to talk to a psychiatrist prior to obtaining medication for psychological treatment. A psychiatrist will monitor symptoms, side-effects, and the course of medication.[8]

Medications are not a full treatment and often include side-effects. Medication helps to cope with symptoms, not fully treat a disorder. Therapy is often most beneficial, and medications can accompany treatment in tandem.

If obtaining medication, seek a psychiatrist whom you trust to talk to about your moods, symptoms, medication, and overall well-being.

Be involved in the treatment process. Generally, outcomes for treating CD are poor when parents are not involved in treatment.[9] It’s important for parents to remain committed to treatment for their child. Commit to regular appointments, show up on time, and follow through with any assignments the therapist asks you to do between sessions.

Because parental involvement is so important, find a therapist who has evening hours and have childcare set up if needed. Choose a therapist whom you feel aligned with and your child feels comfortable talking to.

Engage in parent education. Therapists will include parents in treatment and sometimes require sessions with just the parents. Parent education may include learning which problems to ignore and which to address, giving children clear and not vague instructions for behavior, and teaching communication skills and conflict resolution skills.[10]

A therapist may involve you in “homework” to work on skills at home or have you practice interactions with your child. Follow through on these tasks.

Remove parental blame. Parents may feel like a failure or feel like they have let their child down. Parents may feel hopeless or helpless in dealing with the child’s behavior. Some parents may feel like they have created the problem for their child, or they may blame the child harshly for the child’s behavior. It’s important to remove blame and find better ways to handle the difficult situations.[11]

Parents can learn through modeling or role playing how to more effectively monitor their child’s behavior and supervise their child.

A therapist can help you work through feelings of blame toward yourself or toward your child.

Address inconsistent parenting. Many parents struggle to provide consistent parenting to the child with CD. This can include difficulty providing a supportive and nurturing environment, inconsistent discipline, and overly-relying on punishment to address bad behaviors.[12] Without placing blame on the child, family, or parents, therapy will help build more consistent patterns for the family.

This may include creating a schedule for the day for all children, keeping consequences, rewards, and punishments clear-cut, and encouraging the parents to act with compassion toward their children, even when the children are difficult.

Work on age-appropriate skills. For children ages 3-12, treatment is different than from adolescents. Treatment is focused on play, bonding with the child, developing a positive and consistent parent-child relationship, using praise and rewards to encourage positive behaviors, reorganizing the child’s day to reduce or prevent problems, giving clear directions and expectations of the child, and using clear and consistent consequences in a calm manner.[13]

For adolescents, a great deal of family work occurs in treatment. Skills such as functional communication between parents and teens are learned, practiced, and monitored. Parents and teens learn to communicate emotions and needs in a more adaptive way.[14]

Create a behavior plan. Parents and children may discuss the situations which are most difficult for them. One by one, the therapist can help the family create a behavior plan for each behavior. These behavior plans help both the parent and the child to respond more beneficially in these instances. The plan clearly states what behaviors are ‘target’ (desired or undesired) behaviors and what changes are required. Consequences, as well as preferred behaviors, are expressed. Behavior plans allow children a predictable way to handle situations and allow parents a consistent way to enforce consequences.[15]

For example, one item may be disrespectful behavior. These may include talking back, swearing at a parent, mumbling under the child’s breath, rolling eyes, etc. The consequences for these behaviors may include taking away internet privileges, enforcing an earlier bedtime, or adding chores. Having predictability for the child and the parents can help both to handle the situation more effectively.

Use a cognitive behavioral approach in therapy. Cognitive-behavior therapy (CBT) assumes that thoughts, feelings, and behaviors are intimately connected and influence each other. Maladaptive or ‘bad’ behaviors are seen as learned in response to a perceived reward or consequence. With this in mind, therapists believe that maladaptive behaviors can be “unlearned” and replaced with more positive, prosocial behaviors through navigating new rewards and consequences.[16]

For example, a child may want attention and may not know how to go about getting positive attention. The therapist can work with the behaviors and show the child that he or she can receive attention from parents in a positive way and that the outcomes are more positive for the parents and the child.

Some common goals of therapy for children include reducing aggression (shouting, kicking, hitting), increasing prosocial behaviors (interacting well with peers, engaging in conversations), correcting distorted thoughts and inaccurate self-evaluations (such as “everyone is out to get me” or “I’m no good at anything”), and addressing self-control and emotional stability.[17]

Address destructive or negative thoughts. Thoughts are an important consideration to address, as thoughts can motivate behaviors. If a child has a negative, overgeneralized, or exaggerated understanding of a situation, this can lead to negative behavior. Therapy aims to target these false or maladaptive beliefs and replace them with positive, adaptive beliefs.[18]

For instance, a child may believe, “All people are against me and I must always react defensively.” The therapist may challenge this belief and encourage the child to replace the belief with something like, “There are many people who care about me and want what’s best for me. Even if I don’t consider it what’s best for me, I know their actions are motivated by caring for me.”

Reframe negative or stressful events. A therapist can work with a child to reframe stressful events. This can be especially beneficial for treating anger. For many children with CD, anger tends to be the first line of defense. A therapist can help the child to diffuse the anger response by practicing relaxation techniques (such as deep breathing) and taking a moment to reframe the situation before it gets out of hand.[19]

For example, a child may instantly respond in anger when told a command, such as “do your work and stop being distracted.” A therapist can help bring awareness to the anger (by increasing self-awareness in the body) and allow the child to find alternative ways to interpret the situation. Instead of feeling threatened by the command or angry that the child is being singled out, the child can learn to self-monitor and think, “I’m not focused right now, and this person is trying to help me.”

Approach treatment from all directions. A layered or multisystemic treatment of conduct disorder includes working with the family, peers, neighborhood, and school to approach the behaviors as being linked to various sources.

For instance, peers may contribute to encouraging bad behavior or schools may have ineffective consequences for handling bad behavior.

The goals of this kind of approach are to encourage the child to disengage from deviant peers, build stronger bonds at home and at school, to enhance family skills, and to achieve greater social and academic competence.[20]

Stick with it. Treating a child with CD can be difficult on everyone involved. Stay hopeful and continue with treatment. Treating conduct disorder is a long-term commitment, so don’t expect to see radical changes right away. Above all, remember to see and praise the positive aspects in the child. It is possible to recover from CD.

Advertisement

Community Q&A

Warnings

While parental involvement in important, many parents struggle with their own mental health issues: many parents of children with conduct disorder tend to exhibit symptoms of depression, substance abuse, or antisocial personality traits.[21] These disorders can affect the interactions between parent and child, and may contribute to parental inconsistency, harshness, and attachment with the child. It can be beneficial for some parents to obtain their own individual therapy.

About This Article

This article was co-authored by Trudi Griffin, LPC. Trudi Griffin is a Licensed Professional Counselor in Wisconsin. She received her MS in Clinical Mental Health Counseling from Marquette University in 2011.